Patients commonly experience lulls in their treatment during the course of their visits to the emergency department (ED). Following the triage of patients, they often wait to be brought back to a room. After initial assessments, they may also need to wait during the diagnostic testing and treatment phases. Wait times can also increase as physicians review patient information and make discharge or admission decisions. During these lulls, emergency physicians may be distracted by the urgent needs of other patients and delays can occur. Expeditors: The Maître d’ of the ED A smoother, more efficient operations model in the ED may help anticipate delays in care. For example, a maître d’ controls the flow of patrons in restaurants, ensuring that guests who arrive are seated quickly, their needs are met, and the table is turned over efficiently for the next customers. With this model in mind, we created a new position at Oregon Health & Science University (OHSU) called an “expeditor” who acted like a maître d’ at a restaurant. The expeditor’s primary responsibility was to ensure patient care moved forward. Other responsibilities included: Communicating with and reassessing patients in the waiting room. Rooming patients as directed by the charge nurse. Assisting with ambulance arrivals. Ensuring pain was controlled and providing analgesics as directed. Placing IVs, drawing labs, and running point-of- care tests. Assisting with the discharge processes (eg, removing IVs and helping patients get dressed). Facilitating patient transport to inpatient units. In the May 2011 Western Journal of Emergency Medicine, my colleagues and I had a study published in which we analyzed the effect of using an expeditor...

If you wonder why hospitals are under fire for outrageous and often baffling accounting practices, look no further than a brief paper published last month in Archives of Internal Medicine. Hospital charges for straightforward appendectomies done for acute appendicitis in California in 2009 were examined with the following inclusion criteria: Patients between the ages of 18 and 59 Hospital stays fewer than 4 days Discharged home For the more than 19,000 records reviewed, the median hospital charge was $33,611 with a low of $1,529 and a high of $182,955. Not included in the article but mentioned in news stories about the paper were more details about the care of the two patients at the extremes of charges. From the Huffington Post: “The costliest bill, totaling $182,955, involved a woman who also had cancer. She was treated at a hospital in California’s Silicon Valley. Her bill didn’t show any cancer-related treatment. The smallest bill, $1,529, involved a patient who had her appendix removed in rural Northern California. Otherwise, the cases were similar: Both patients were hospitalized for one day, had minimally invasive surgery, and had similar numbers of procedures and tests on their bills.” A California Healthline story about this clarifies the issue. It said: “Dave Glyer, CFO for Community Memorial Health System, said that the study ‘assumed that hospital charges matter when they don’t,’ making it ‘completely off base.’ He said that insured patients pay rates negotiated by health insurers and that certain uninsured patients are aided by assistance programs.” It’s all clear to me now. Hospital charges don’t matter. What if you have no insurance and are not...